Individual provider · Type 1 NPI

Mia Kimiko Desoto

Nurse Practitioner · Fairfield, CA

NPI number 1528986940 Active

Practice location

1860 Pennsylvania Ave Ste 230
Fairfield, CA 94533-3550

Call (707) 646-4370 Map

Mailing address

313 Shaker Dr
Vacaville, CA 95687-8022

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000X95038894 (CA)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1528986940

Mia Kimiko Desoto's National Provider Identifier is 1528986940, issued on Jul 6, 2026. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Fairfield, CA. The record was last updated on Jul 6, 2026.